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CAVANAUGH: This is KPBS Midday Edition. I'm Maureen Cavanaugh. In the investigation into the Colorado theatre shooting, before the massacre, James Holmes sent a notebook to a psychiatrist at the university of Colorado. Reports are the book was filled with violent images of shootings, but it's not clear whether James Holmes had any counseling from the psychiatrist while he was a PhD. Candidate at the university or that the psychiatrist had even seen the book before the shootings. College mental health councils hear about a lot during these critical years for students. And these are the years that serious mental illness tends to develop in the population. Joining us, sandy Jorgensen is director of psychological services at San Diego state university.

CAVANAUGH: Alfredo Aguirre is director of mental health services.

AGUIRRE: Good afternoon.

CAVANAUGH: What types of mental illnesses can we see in this age range?

AGUIRRE: Well, it's known that for more serious types of illness, the onset is often in the young adult stages, and many of your students at this campus are in that age bracket. But of course there are other disorders, students and young adults who are suffering from some form of depression, anxiety, you know, panic attacks, those kinds of things, that can surface often during the young adult period.

CAVANAUGH: Do we know why they seem to manifest themselves during -- and the age rage is 18-25?

AGUIRRE: Actually it's younger. You can see the onset at 15 or season through the age of 25, and yes, it's very typical. If you look at people in our system with serious mental illness, many of them may have been in the children's system, but perhaps with other problems like anxiety or perhaps obsessive compulsive types of issues. So they were maybe predisposed or had signs of a more serious illness that would manifest later on in their life.

CAVANAUGH: Do we know why this happens? Is there anything about the way the brain is developing at this time that can trigger an onset of schizophrenia or bipolar or depression or anything like that?

JORGENSEN-FUNK: You know, I think there's a lot of research that's been conducted on just that question. And there's -- I'm imagining a variety of different causal reasons. Some students will come to us, and there are certain kinds of stress factors that are involved in the issues that they're struggling with that result in different kinds of symptoms. Will others suspect that there are biological factors and issues with the brain.

CAVANAUGH: Those biological factors can start to manifest themselves in the middle teens.

AGUIRRE: Absolutely. And sometimes you'll see it, especially in young adults, they begin to isolate themselves, they begin to not be as connected socially. They begin to again not be involved in activities they were involved in before. Less interests in their studies, real difficulty sometimes in concentrating. It's what we often see with these individuals.

CAVANAUGH: Doctor Jorgensen-Funk you work with students specifically on the campus of San Diego state university. Knowing this is the age range where mental illness can surface, what type of support is provided here at SDSU when student comes in and express different feelings of being overwhelmed or unsettled or anxiety or present a number of psychological issues?

JORGENSEN-FUNK: At our center on campus, we try to provide as wide range of services as we think would possibly be useful so we can support students in a variety of ways. Online resources, a center for well-being in our office, we provide phone consultation to -- available for all students, staff, faculty members, parents who are concerned. We also provide brief counseling, individual couples, group council, we do a tremendous amount of outreach work and workshops, out on campus sometimes with tabling events really trying to communicate with students about the services that we have in a wide range of ways.

CAVANAUGH: There's a lot of emphasis put on academic records when one enters college or university. Is there any routine screening done on incoming students to evaluate mental health?

JORGENSEN-FUNK: No, there isn't.

CAVANAUGH: Do you think there should be?

JORGENSEN-FUNK: You know, I actually don't think there should be. What we do is provide for all incoming freshmen an online intervention tool that addresses alcohol and substance abuse, because that is a risk factor. But I think it would be -- I don't think it would be a good idea to be screening students for mental health issues for a variety of reasons. We don't want students to feel stigmatized about whatever they're dealing with. We don't want students to feel as though they're going to be blocked from being able to enter. We want them to be able to come in, and our goal is to provide as much information as possible about the services we have. There are student disabilities service office on campus, and they provide accommodations for students. We want students to know about that so they can access those services, and we want them to know about our services. So if there is a particular concern they have, not to prevent them from being able to come into campus, but being able to support them while they're with us.

CAVANAUGH: I want to talk about the stigma of having a mental health issue manifest itself, of having an illness. Is that going away or are we still dealing, grappling with that being a stumbling block?

AGUIRRE: We have a major campaign here in San Diego, and when we did a survey about their opinion of mental illness, whether or not they would allow a family member to marry someone with a mental health disorder, there was a high degree of stigma. We came back a year later and found out that those numbers have decreased. There seems to be more awares, more acceptance of people with mental illness in their families, within their communities. I think we are making a dent but we still know that that can keep individuals from seeking help, get in the way of families providing the support, friends from providing the support, and the general community from offering support. Fortunately we forged a very strong relationship with higher education, our community college, UC San Diego, providing material, brochures, posters about mental health awareness, and that has seemed to make a big difference. Those materials are available to provide a stronger more community support as well as people's ability to seek help.

CAVANAUGH: It seems to me I remember a few years ago there was a controversy over a certain test that was being given in some school districts to evaluate in high school students' mental health. There was a great deal of controversy over that because of the idea that you're going to start to label kids, you're going to have them think they have some kind of illness when what they're going through is just adolescence of the what is your idea about these screening tests and their value?

AGUIRRE: I think it's important, it's one source of information to help guide our efforts to develop suicide prevention activities. San Diego unified school district every two years does a confidential survey of students on whether they have actually made an attempt on their life. And the numbers are pretty stable, but they're a little higher than we would like. They're pretty consistent with the state average. But that guides our efforts and really directs resources. For example we have a suicide prevention effort working in various schools with the San Diego unified school district. That information was helpful, and that information is in the San Diego children's report card. That's one of the variables they look at in terms of children's health in the community.

CAVANAUGH: We're talking about this in reference to what happened in Colorado. And the discovery that indeed there was some sort of reaching out by the suspect toward a mental health professional on the campus of the university of Colorado. We don't know exactly what was involved in that. But it's gotten some of us to remember that a graduate student at SDSU shot and killed three faculty numbers back in 1996. Doctor, did that make you reevaluate or the school reevaluate what was needed and how you could offer support for both the students and the faculty?

JORGENSEN-FUNK: I think both that incident as well as other incidents that occur at other universities and colleges around the country causes all of us rightfully so to take a look at the services that we provide and how students are impacted by the stressors that they're dealing with, and what we can do to support them as best as possible. So yeah, following that incident back, I think it was in 1996, we too looked at our services. In following Virginia tech, we did the same. And what we've really tried to put in place is an opportunity for any student, staff, or faculty member who's concerned about a student to be able to call our office and talk with a therapist by telephone that same day. And consult with us about concerns that they're having. And if it's an urgent situation, then be able to see that student for a same-day appointment. We also have done other things on campus in terms of bringing together a large group that represents departments across the campus that really take a look at situations of concern, students that may be struggling and be able to put our minds together about how we can really intervene in a positive way.

CAVANAUGH: Can you offer a recurrent intervention? In other words can you offer recurrent counseling to a student who's going through a difficult time or do you refer them off to a counselor in the community?

JORGENSEN-FUNK: Both things may happen. We initially have that first conversation with the student, get a sense of what their concerns are, what they're dealing with, and often we'll see the student in our office. And we can provide brief therapy so that's ongoing, weekly counseling. If the student comes in and they're dealing with an issue that warrants more long-term comprehensive services, then we will provide them referrals out to the community. We've established a very strong pool of great providers out in the community that we're able to refer to.

CAVANAUGH: How can you tell the difference between a student who's going through a difficult crisis oriented situation where they're freaked out about their academic scores or there's trouble at home, and someone who is maybe decompensating mentally into a downward spiral. How do you go about discerning that? College time can be a place where people are crazy and mixed up, just in a general basis. How do you make that distinction?

JORGENSEN-FUNK: The student will meet with one of our therapists. We have highly trained therapists in our office, licensed clinicians, and they'll meet with the student, and they'll do an assessment to determine what kinds of issues the student is dealing with, look at the symptoms that they're experiencing. History of the issues, and from that assessment, they can make a determination about the next best step, whether it's continuing to see that therapist in counseling or perhaps additional kinds of assessments that might be helpful. It may be referring the student for a medication evaluation, those kinds of things that we do on a daily basis.

CAVANAUGH: Alfredo, this countywide outreach program, it seems that attitudes may be changing about mental health. Tell us how across the board you think this outreach is changing the way people are responding to their own personal mental health issues.

AGUIRRE: Well, certainly we try to track the number of calls that come into our access and crisis line, which by the way is 18887247240. People can call that 24 hours a day, seven-days a week, and we are starting to see more -- a higher incidence of individuals calling that they've seen material about it's up to us, they have gone to the website, 2SD.org, and they've gotten material, perhaps a family member who's become aware, maybe my 17-year-old who is hold up in his room behind his computer and no longer connects with friend, maybe there's something going on here. And they are by this outreach effort realizing that there's a place to call. So we're starting to see an increase in that.

CAVANAUGH: I've seen some of the commercials, and I think they're really exceptionally well-done. And speaking of that kind of visual outreach, on SDSU's website there's a new video sort of talking about the mental health services that are available on campus. And that's really a very powerful video. It tells people how many students are actually going through some sort of anxiety or crisis, and they're not talking about it.

JORGENSEN-FUNK: True. We participated in a study called the healthy mind study, and we're one of a number of campuses that did this, and it randomly sampled 4,000 of our students and asked them a long series of questions. One of the things that came from that, we created this video. And it helps us to really understand the number of students on our campus who are experiencing anxiety or depression or who are thinking about hurting themselves. And it is very powerful. It also provided us some information about the stigma that you were talking about earlier. About half the students indicated that they do believe that someone will have a negative opinion about someone who's seeking mental health services. So there's still that stigma, and as Alfredo mentioned, we're really excited about this collaboration that we're having with the county, as well as with other universities. That's part of the cal mesa mental health services association funding. And it's allowing us this coming academic year to have a greater presence across the entire campus and to be able to go out and do trainings for staff and faculty about the warning signs or how to identify a distressed student, how to get them connected with our services, and to have a whole group of wonderful peer educators go out and do outreach with our students and tabling on campus, all those activities that we are anticipating will really help students to know more about our services, and to really reduce the stigma and discrimination that occurs related mental health services.

CAVANAUGH: I appreciate your coming in and talking to us about this today.